Everyday Solutions are created by Everyday Health on behalf of our partners.
More Information

Content in this special section was created or selected by the Everyday Health editorial team and is funded by an advertising sponsor. The content is subject to Everyday Health’s editorial standards for accuracy, objectivity, and balance. The sponsor does not edit or influence the content but may suggest the general topic area.

They're called disease-modifying anti-rheumatic drugs, or DMARDs for short. For people with rheumatoid arthritis, these medications can help make life much more manageable.

More RA Tips

Research trials looking into how effective the cancer drug methotrexate would be in relieving painful rheumatoid arthritis (RA) symptoms began in 1981. In one study published in 1985 in the New England Journal of Medicine, participants given methotrexate experienced a significant improvement in their RA symptoms, reporting fewer painful joints and less tenderness and morning stiffness after 12 weeks. A year later, another study was published in the journal Arthritis and Rheumatism and reported that methotrexate was effective for treating RA long-term, over a period of 29 months.

Other studies were also published, and in 1988 methotrexate received approval from the U.S. Food and Drug Administration (FDA) as an RA treatment, says Joel M. Kremer, MD, Pfaff Family Professor of Medicine at Albany Medical College, and director of research at the Center for Rheumatology in Albany, N.Y.

Methotrexate is now a frontline medication for RA, a joint-wasting, autoimmune condition that may affect other organs. It's a cornerstone drug called a disease-modifying anti-rheumatic drug (DMARD), a class of drugs to which newer DMARDs have been added. Newer DMARDs can slow the disease's progression.

The History of DMARDs

While the term DMARD may seem relatively new, the history of DMARDs actually began decades ago, even before the arrival of methotrexate. “DMARDs have been around for a long time,” Dr. Kremer says.

Perhaps the earliest DMARD is sulfasalazine. Developed in the 1940s, it was designed as an anti-inflammatory combined with an antibiotic.

Then, in the 1950s, doctors began to prescribe methotrexate for psoriasis, Kremer says. “There were so few treatment tools available then, so doctors were doing creative things.” Once word got out that people with psoriasis were being helped, doctors began prescribing it for people with RA. Anecdotal reports led to clinical studies and an eventual FDA approval.

In the late 1990s came biologic DMARDs — these drugs came in rapid succession, and now there are many different biologic DMARDs available, each with different mechanisms of action, Kremer says. These drugs, derived from living cells, target specific molecules in the immune system, and are administered either intravenously or by injection. Older DMARDs don’t stop the disease’s progression, Kremer says, but they do have some effect on slowing down the disease. ”Biologic DMARDs, when combined with methotrexate, are much more effective than when used alone,” he says.

RA and DMARDs Today

Many biologic DMARDs that are available today are all still under patent, which makes them very expensive. But even when they come off patent, they may not come down in price, as they’re not going to be significantly cheaper to make because they’re made from living cells.

The various types of available biologics are divided into a few different classes. Tumor necrosis factor (TNF) inhibitors are designed to keep TNF alpha, a molecule that promotes inflammation, from doing its job. Other types of biologics, including IL-1 blockers, IL-6 blockers, T-cell co-stimulation blockers, and anti-CD-20 antibodies, are designed to interfere with other components of the immune system that put it into overdrive and cause inflammation. In 2012, a new type of oral medication, a so-called JAK inhibitor, was approved for rheumatoid arthritis

When it comes to treating RA, “each type of drug has its own issues, but one isn’t better than another, per se,” Kremer says. “Individual circumstances determine how well a drug will work for you,” he says.

The Future of RA Treatment

Just around the corner are biosimilars, Kremer says. These are drugs with a similar structure to biologic DMARDS that will be “generic” biologics, and are likely to cost about 80 percent less than what biologics cost, which is still expensive.

As RA treatment progresses, Kremer says that many people with RA may have what’s called a “secondary failure,” where they no longer respond to one drug so they need to be switched to another. “Not everyone will have this problem. A number of genetic studies are being done on this, but data are preliminary.”

Kremer says researchers are also studying comorbidities of RA, — which are conditions that go hand in hand with RA. One risk factor is cardiovascular disease. People with RA often have hardening of the arteries, stroke, even heart failure. The reason is that plaque will react rapidly in the presence of inflammation in the body.

“There’s a lot of research that’s come out on this,” Kremer says. As for new RA medicines, he foresees more biologics in the form of new oral drugs that will act in the same way as current biologics.

Is there a cure for RA in the future? “We’re a long way from an actual cure, but we’re controlling the condition and putting it into remission,” he says.

This site complies with the HONcode standard for trustworthy health information: verify here.

Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about
your visits to this Site and other websites in order to provide advertisements about goods and services of
interest to you. If you would like to obtain more information about these advertising practices and to make
choices about online behavioral advertising, please click here.